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Phencyclidine Intoxication
DSM-III In DSM-III, this disorder is called Phencyclidine (PCP) or Similarly Acting Arylcyclohexylamine Intoxication Diagnostic Criteria A'''. Recent use of phencyclidine or a similarly acting arylocylohexylamine. '''B. Within an hour (less when smoked, insufflated, or used intravenously), at least two of the following physical symptoms: # vertical or horizontal nystagmus # increased blood pressure and heart rate # numbness or diminished responsiveness to pain # ataxia # dysarthria C'''. Within one hour, at least two of the following psychological symptoms: # euphoria # psychomotor agitation # marked anxiety # emotional lability # grandiosity # sensation of slowed time # synesthesias '''D. Maladaptive behavioral effects, e.g., belligerence, impulsivity, unpredictability, impaired judgment, assaultiveness. E'''. Not due to any other physical or mental disorder, e.g., Delirium. '''Differential Diagnosis Other Substance-induced Intoxications that cause a similar clinical picture, such as those due to amphetamines and hallucinogens, may be ruled out by the presence of phencyclidine in the urine or plasma. DSM-IV For more information, see'' Substance Intoxication'' The essential feature of Phencyclidine Intoxication is the presence of clinically significant maladaptive behavioral changes (e.g., belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment, or impaired social or occupational functioning) that develop during, or shortly after, use of phencyclidine (or a related substance) (Criteria A and B). These changes are accompanied by two or more of the following signs that develop within an hour of using the substance (or less when it is smoked, "snorted," or used intravenously): vertical or horizontal nystagmus, hypertension or tachycardia, numbness or diminished responsiveness to pain, ataxia, dysarthria, muscle rigidity, seizures or coma, and hyperacusis (Criterion C). The symptoms must not be due to a general medical condition and are not better accounted for by another mental disorder (Criterion D). Specific signs and symptoms are dose related. Lower doses of phencyclidine produce vertigo, ataxia, nystagmus, mild hypertension, abnormal involuntary movements, slurred speech, nausea, weakness, slowed reaction times, euphoria or affective dulling, loquacity, and lack of concern. Disorganized thinking, changed body image and sensory perception, depersonalization, and feelings of unreality occur at intermediate doses. Higher doses produce amnesia and coma, with analgesia sufficient for surgery, and seizures with respiratory depression occur at the highest doses. Effects begin almost immediately after an intravenous or transpulmonary dose, reaching a peak within minutes. Peak effects occur about 2 hours after oral doses. In milder intoxications, the effects resolve after 8-20 hours, whereas signs and symptoms of severe intoxications may persist for several days. Phencyclidine-Induced Psychotic Disorder may persist for weeks. Diagnostic Criteria A'''. Recent use of phencyclidine (or a related substance). '''B. Clinically significant maladaptive behavioral changes (e.g., belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgment, or impaired social or occupational functioning) that developed during, or shortly after, phencyclidine use. C'''. Within an hour (less when smoked, "snorted," or used intravenously), two (or more) of the following signs: # vertical or horizontal nystagmus # hypertension or tachycardia # numbness or diminished responsiveness to pain # ataxia # dysarthria # muscle rigidity # seizures or coma # hyperacusis '''D. The symptoms are not due to a general medical condition and are not better accounted for by another mental disorder. Specify if: * With Perceptual Disturbances Specifier The following specifier may be applied to a diagnosis of Phencyclidine Intoxication: With Perceptual Disturbances This specifier may be noted when hallucinations with intact reality testing or auditory, visual, or tactile illusions occur in the absence of a delirium. Intact reality testing means that the person knows that the hallucinations are induced by the substance and do not represent external reality. When hallucinations occur in the absence of intact reality testing, a diagnosis of Substance-Induced Psychotic Disorder, With Hallucinations, should be considered. DSM-5 Diagnostic Criteria A'''. Recent use of phencyclidine (or a pharmacologically similar substance). '''B. Clinically significant problematic behavioral changes (e.g., belligerence, assaultiveness, impulsiveness, unpredictability, psychomotor agitation, impaired judgement) that developed during, or shortly after, phencyclidine use. C'. Within 1 hour, two (or more) of the following signs or symptoms: ('Note: When the drug is smoked, "snorted," or used intravenously, the onset may be particularly rapid). # Vertical or horizontal nystagmus. # Hypertension or tachycardia. # Numbness or diminished responsiveness to pain. # Ataxia. # Dysarthria. # Muscle rigidity. # Seizures or coma. # Hyperacusis. D'''. The signs or symptoms are not attributable to another medical condition and are not better explained by another mental disorder, including intoxication with another substance. '''Differential Diagnosis In particular, in the absence of intact reality testing (i.e., without insight into any perceptual abnormalities), an additional diagnosis of phencyclidine-induced psychotic disorder should be considered. Other substance intoxication Phencyclidine intoxication should be differentiated from intoxication due to other substances, including other hallucinogens; amphetamine, cocaine, or other stimulants; and anticholinergics, as well as withdrawal from benzodiazepines. Nystagmus and bizarre and violent behavior may distinguish intoxication due to phencyclidine from that due to other substances. Toxicological tests may be useful in making this distinction, since phencyclidine is detectable in urine for up to 8 days after use. However, there is a weak correlation between quantitative toxicology levels of phencyclidine and clinical presentation that diminishes the utility of the laboratory findings for patient management. Other conditions Other conditions to be considered include schizophrenia, depression, withdrawal from other drugs (e.g., sedatives, alcohol), certain metabolic disorders like hypoglycemia and hyponatremia, central nervous system tumors, seizure disorders, sepsis, neuroleptic malignant syndrome, and vascular insults.